E. Coli Outbreaks in Potato Salad and Wading
Pool

DOCTOR'S VIEWS ARCHIVE

Two different types of Escherichia coli
(E. coli) bacteria have been held responsible for new
outbreaks in the United States, one in Illinois and the
other in Georgia.

Potato Salad in Illinois

In Orland Park, Illinois near Chicago, more than 4,000
people took sick after eating potato salad prepared by
Iwan's Deli and Catering for more than 530 parties over the
weekend of June 6, a busy weekend for graduations. This is
the largest known outbreak in the U.S. of the
enterotoxigenic strain of E. coli (ETEC).

ETEC has been generally viewed as a disease of
developing countries. It is a common cause of diarrhea
among children in the developing countries and among
travelers to these countries. ETEC remains the most common
cause of traveler's diarrhea or "Montezuma's revenge".
However, the Illinois outbreak is an obvious reminder that
ETEC is not foreign to the U.S.

ETEC infection is acquired mainly through eating food
and drinking water that are contaminated with the bacteria.
Toxins produced by the bacteria in the small intestine
cause profuse diarrhea. Most people recover in 3-5 days,
although severe dehydration can occur in the very young and
the elderly.

ETEC is one of the reasons that restaurants often have a
sign reminding employees to wash their hands before leaving
the rest room. Everyone should.

Wading Pool in Georgia

A more dangerous strain of E. coli called O157:H7
struck at least 19 children in Northwest Atlanta. Four of were critically ill with the hemolytic-uremic syndrome,
a grave complication of this form of E. coli. One of the
critically ill children was Brody, the 3-year-old son of
Walt Weiss, shortstop on the Atlanta Braves baseball
team.

E. coli 0157:H7 causes about 20,000 cases of hemorrhagic
(bloody) colitis (inflammation of the bowel) each year in
the U.S. In a widely publicized outbreak in 1993 in
Washington State, hundreds became ill and 3 died from E.
coli 0157:H7 that was tracked to undercooked hamburgers
from Jack in the Box restaurants. Undercooked ground beef
is a prime food source for this infection. For this reason,
hemorrhagic colitis due to E. coli 0157:H7 is commonly
referred to as "hamburger disease."

Toxins (poisons) produced by E. coli 0157:H7 are
responsible for the bloody diarrhea (hemorrhagic colitis)
and the dire complications of thrombotic thrombocytopenic
purpura (TTP) and the hemolytic-uremic syndrome (HUS).

Hemorrhagic diarrhea (hemorrhagic colitis) due to E.
coli 0157:H7 involves diarrhea with painful abdominal
cramps. The diarrhea is severe, usually with gross blood in
the stool, little or no fever, and lasts for 6 to 8 days.

Thrombotic thrombocytopenic purpura (TTP) involves
anemia due to fragmentation of red blood cells, shortage of
platelets (thrombocytopenia) with easy bruising, neurologic
abnormalities, impaired kidney function, and fever. TTP is
still a serious consequence from E. coli 0157:H7, one to
which the elderly are particularly prone.

Children are particularly prone to develop the hemolytic-
uremic syndrome (HUS). "Hemolytic" refers to the breakup of
red blood cells. This leads to anemia. There is a shortage
of platelets (thrombocytopenia) which causes abnormal
bleeding. "Uremic" refers to the acute kidney failure.
Central nervous system problems with seizures and coma can
also occur.

Brody Weiss and the other children in Atlanta with E.
coli 0157:H7 are thought to have contracted it in a wading
pool at White Water Recreation Park. Tests there revealed
chlorine levels below the level needed to kill E. coli
0157:H7.

Georgia health officials have sketched out this scenario. A child
with E. coli 0157:H7 defecated in the wading pool at the park. Other
children swallowed the contaminated water. The original E. coli kid
returned the next day and repeated the scenario. And, finally, yet
another fecal accident (possibly by a child who had become infected
at the pool) occurred some days later, infecting still more
children.

Three of the children including Brody Weiss are reported
to be in critical condition with kidney failure at the
Scottish Rite Children's Medical Center (The location of
the fourth child is not known). All of the children are
aged 2 to 4.

The hemolytic-uremic syndrome from which they suffer is
now the most common cause of acute renal failure in infants
and young children.

For more information on this dangerous bacteria E. coli
0157:H7, and how to prevent contracting the infection,
please visit the MedicineNet.com Forum on E. coli 0157:H7